Orthopedic Emergency Department Research Articles

Implementation of Inhaled Methoxyflurane for the Reduction of Distal Radius Fractures in a Third-Level Hospital: A Descriptive Cohort Study

Orthopedic emergencies due to fractures are one of the main reasons for surgical intervention. The distal radius is a structure prone to fractures, particularly in young people. The main objective of this study was to evaluate the success rate of methoxyflurane in the reduction in distal radius fractures that required conservative treatment. The medical records of all the patients with Frykman type I and type II distal radius fractures who underwent fracture reduction with methoxyflurane or propofol from December 2021 to January 2023 were reviewed. The success rate of distal radius fracture reduction with methoxyflurane was analyzed, and the secondary outcomes, such as the recovery time and length of stay in the orthopedic emergency department, were assessed and compared with propofol. A total of 145 patients with distal radius fractures presented to the emergency department during the study period. Seventy-five patients met our inclusion criteria. Fifty patients had a fracture reduction with methoxyflurane, while twenty patients received propofol. The median recovery time and reduction duration were 30 min and 65.5 min, respectively, resulting in a shorter period for the methoxyflurane group. Methoxyflurane was successfully used in 48 of the 82 patients undergoing Frykman type I and type II distal radius fracture reduction while improving the recovery time due to its easy self-delivery and rapid effectiveness in the patient, as well as being able to estimate the level of pain so that the amount of anesthetic needed can be estimated and adverse effects avoided. Methoxyflurane represents a great candidate for surgical interventions like the reduction in distal radius fractures.

DORIS study: domestic violence in orthopaedics, a prospective cohort study at a Swedish hospital on the annual prevalence of domestic violence in orthopaedic emergency care

BackgroundDomestic violence (DV) is a major problem which despite many efforts persists globally. Victims of DV can present with various injuries, whereof musculoskeletal presentation is common.ObjectivesThe DORIS study (Domestic violence...

Inappropriate Pediatric Orthopaedic Emergency Department Transfers: A Burden on the Health Care System.

Though the importance of level 1 pediatric trauma has repeatedly been shown to lessen both morbidity and mortality in critically injured children, these same tertiary referral centers also receive numerous transfers of patients with less severe injuries. This not only leads to increased costs and use of limited facility resources but, oftentimes, frustration and unnecessary expense to those families for whom transfer was avoidable. Prior work has demonstrated that half of all inappropriate pediatric interfacility transfers are due to orthopedic injuries. This study aims to evaluate the incidence of inappropriate transfers of pediatric patients with isolated orthopedic injuries to a pediatric level 1 trauma center and identify factors associated with such transfers. All patients transferred to a large metropolitan level 1 pediatric trauma center for isolated orthopedic injuries over a 6-year period were retrospectively evaluated. Medical records were reviewed for demographic and injury data, including age, gender, race, social deprivation index, insurance status, location of transferring institution, timing of transfer, and availability of orthopedic on-call coverage at transferring institution. The transfer was deemed to be appropriate if the patient required a sedated reduction, was admitted to the hospital, or was taken to the operating room within 24 hours of transfer. Regression analysis was reviewed for each of the demographic, patient, and transfer characteristics in an attempt to isolate those associated with inappropriate transfer. In all, 437 transfers occurred during the study period. Of these, 112 (26%) were deemed inappropriate. 4% of patients transferred for orthopedic injuries did not receive an orthopedic consult following the transfer. Non-white patients were more likely than white patients to be transferred inappropriately (34.01% vs. 21.58%, P=0.009 ). No other demographic characteristic was predictive of inappropriate transfer. There was no difference in the rate of appropriate transfer between patients with private insurance versus government-funded, self-paying, or uninsured patients. The timing of transfer (night vs. day and weekday vs. weekend) did not affect the appropriateness of transfer. Facilities with orthopaedic on-call coverage were more likely to inappropriately transfer patients than those without (26.6% vs. 23.4%, P<0.001 ). A quarter of patients transferred for isolated orthopaedic injuries were inappropriately transferred. Unlike studies published in adult literature, the timing of transfer (overnight and weekend) and the insurance status of the patient did not appear to play a role in the appropriateness of transfer. Inappropriate and unnecessary trauma transfers create a significant burden on tertiary referral centers. Raising awareness of the high incidence of unnecessary transfers coupled with enhanced education of outside emergency medicine providers may result in better stewardship of health care resources, limit delays in patient care, and reduce strain on both the health care delivery system and the families of injured children. Level III-Therapeutic Study.

Proportion of Hidden Vertebral Fractures Among Egyptian Males With Fragility Hip Fractures in the Emergency Room of Ain Shams University Hospitals.

Background Fragility fractures are linked to significant costs for society as well as significant pain and suffering, disability, and even death. It is well-recognized that osteoporosis-related fragility fractures raise the risk of subsequent fragility fractures. One of the most frequent osteoporotic fractures brought on by low bone mineral density and other risk factors is vertebral fractures. Considering that most vertebral fractures are asymptomatic and not clinically identified, proactive screening could stop additional impairment. Objective The current study aims to determine the prevalence and risk factors of hidden vertebral fractures in Egyptian males who have fragility hip fractures. Patients and methods A cross-sectional case-control study examining the correlation of risk factors between cases (fragility hip fracture and vertebral fractures) and a control group (fragility hip fracture without vertebral fracture) was carried out from September 2020 to September 2021 on patients visiting the orthopedic emergency department of a university hospital in Cairo, Egypt. Males who presented to the emergency room (ER) with fragility hip fractures and were 40 years of age or older met our inclusion criteria. For every patient who presented with a fragility hip fracture, standard lateral and anteroposterior radiographs of the dorso-lumbar spine were taken. Results A total of 43,935 patients visited the orthopedic emergency room (ER) throughout the study period; 13,034 of those patients were men, accounting for 29.7% of all orthopedic ER visits. Our inclusion criteria for fragility hip fractures were met by 132 male participants. The screening lumbosacral plain X-rays identified 27 (20.5%) of the 132 patients as having concomitant vertebral fractures in addition to the fragility hip fractures. Concomitant hidden vertebral fractures among Egyptian males with other fragility fractures, particularly fragility hip fractures, are predicted by the number of co-morbid diseases, hypertension, and continuous use of steroids and anti-epileptics. Conclusion Most fragility fractures are avoidable. Because one fragility fracture increases the likelihood of others, early detection is crucial. To prevent complications and mortality, it is important to identify and manage individuals who have a fragility hip fracture as they frequently have concurrent hidden vertebral fractures. Predictive risk factors for fragility vertebral fractures include hypertension, the number of concomitant illnesses, and chronic drugs (anti-epileptics and steroids).

First report of lumbar spinal epidural hematoma after pelvic ring fracture.

Spinal epidural hematoma is a rare condition that most commonly occurs as a complication of spinal surgery. For patients with neurological deficits, surgical decompression can generally provide good outcome. A 56-year-old, otherwise healthy, patient was admitted to the orthopedic emergency department with a pelvic ring fracture. Over the course of 4 days, a lumbar spinal epidural hematoma developed, with the patient complaining of pain radiating to the S1 dermatome and saddle paresthesia. The hematoma was surgically decompressed, and the patient had a complete recovery. To our knowledge, this is the first report of a spinal epidural hematoma after pelvic ring fracture. The etiology of spinal epidural hematoma is diverse, but it is most frequently observed after spinal surgery. It has rarely been observed after lumbar spinal fractures, nearly exclusively in patients with ankylosing spondylitis. Pelvic ring fracture might result in spinal epidural hematoma. The presence of neurological deficits after such fractures is an indication for lumbosacral MRI. Surgical decompression will generally resolve the neurological symptoms.

The impact of the SARS-CoV-2 pandemic-related lockdowns on orthopedic trauma emergencies at a level-one trauma center.

The SARS-CoV-2 pandemic and its associated lockdowns had a profound effect on orthopedic trauma emergencies. This study aimed to investigate the patient volume and injury patterns at a level-one trauma center during the SARS-CoV-2 pandemic and compare them to the pre-pandemic conditions. A retrospective chart review of all patients who presented to the orthopedic trauma emergency department of a level-one trauma center in Cologne, Germany within a 2year period from March 16th, 2019 to March 15th, 2020 (pre-pandemic control) and from March 16th, 2020 and March 15th, 2021 (pandemic) was performed. The pandemic year was separated into three periods: (1) first lockdown, (2) between lockdowns and (3) second lockdown. The absolute numbers of patient presentations, the Manchester triage score (MTS) and the relative proportion of patients with structural organ injuries, fractures and dislocations, of polytraumatized patients, of hospital admissions, of subsequent emergency or semi-elective surgeries and of work-related accidents were evaluated in comparison to the pre-pandemic control. A total of 21,642 patient presentations were included in this study. Significantly less weekly orthopedic trauma emergency patient presentations were recorded during the pandemic (p < 0.01). The MTS was significantly lower during the first lockdown and between lockdowns (p < 0.01). The proportional incidence of overall structural organ injuries, fractures and dislocations, of upper limb fractures/dislocations, of hospital admissions and of patients requiring surgery was significantly increased during the pandemic (p ≤ 0.03). The proportional incidence of work-related injuries was significantly decreased during the pandemic (p < 0.01). Orthopedic trauma emergency presentations were reduced during the SARS-CoV-2 pandemic. Due to the reluctancy of patients to visit the emergency department during the pandemic, the proportions of relevant injuries in general and of upper limb injuries in particular as well as of patients requiring hospital admission and trauma-related surgery were significantly increased.

The Effect of Nationwide Lockdown in India on the Epidemiology of Injuries During the First Wave of COVID-19

Background. The pattern of hospital admissions and medical care changed during the COVID pandemic.&#x0D; The aim of the study to describe the nature of patients attending the orthopedic emergency department of a level 1 trauma center in terms of number and proportion based on demographic characteristics and the nature of the injury before the lockdown, during the lockdown, and during the unlocking period of the nationwide lockdown for controlling the COVID-19 pandemic in India.&#x0D; Methods. We conducted a longitudinal study from 01.01.2020 to 31.12.2020. Patients attending the orthopedic emergency were grouped based on cause, type, and site of injury. The median number observed each day with IQR. The distribution of the same was compared between the prelockdown with lockdown period and the lockdown period with a phased unlocking period.&#x0D; Results. A total of 10513 patients were included. There was a statistically significant reduction in the proportion of patients needing inpatient care between the prelockdown phase and lockdown phase (p = 0.008). However, this was not seen between lockdown and postlockdown periods (p = 0.47). The proportion of road traffic accidents dropped from 26% to 15% during this time (p0.001). The proportion of contusions was reduced and that of soft tissue injuries increased (p0.001). The proportion of lower limb injuries decreased from the prelockdown phase to the lockdown phase, and that of spinal injury patients increased (p = 0.007). The proportion of patients with contusions increased and soft tissue injuries decreased during this period (p0.001). Lower limb injuries and road traffic accidents increased, and spinal injuries were reduced (p0.001).&#x0D; Conclusion. The lockdown for controlling the spread of the pandemic affected the demographic and epidemiological aspects of injuries attending the orthopedic emergency department of a level 1 trauma center in a developing country. There was a decrease in the proportion of females and children attending the ED during the lockdown. The number of road traffic accedents s decreased during the lockdown. The number of patients with contusions attending the trauma center during the lockdown decreased, but there was an increase in the number of patients with spine injuries. We suggest that improvement in triage facilities, wider use of telemedicine, and increasing the stock of PPEs are essential for tackling such situations in the future.

Recent Advances in the Management of Atrophic Tibial Non-Unions; An update using Extra Corporeal Shock Wave Therapy

Background: Tibial nonunion remains a significant clinical challenge despite advances in surgical management. New techniques to help manage tibial nonunion include extracorporeal shock wave therapy and percutaneous application of bone marrow aspirate. Management strategies vary based on the type of nonunion: aseptic or infected, and atrophic or hypertrophic. Extracorporeal shock wave therapy has been shown to be as effective as surgical management in patients with stable hypertrophic nonunion. Objective: To determine the efficacy of extracorporeal shock wave therapy for aseptic non-union of the tibia Methodology: A randomized controlled trail was conducted at Orthopedic Emergency department Central Park Teaching Hospital from March 2022 to November 2022. Results: In our study, out of 120 cases, 52.5%(n=63) were between 15-40 years and 47.5%(n=57) were between 41-60 years of age, mean + sd was calculated as 41.22+7.17 years, 60.83%(n=73) male and 39.17%(n=47) females. Frequency of efficacy of extracorporeal shock wave therapy for aseptic non-union of the tibia revealed in 86.67%(n=104). Practical Implication: ESWT therapy can be used as non-invasive method of treating non-healing fractures of tibia without compromising the surgical anatomy. Conclusion: We concluded that the frequency of efficacy of extracorporeal shock wave therapy for non-union of the tibia is significantly higher and the patients treated with this technique may have a benefit of non-operative procedure. Keywords: Aseptic non-union of the tibia, extracorporeal shock wave therapy, efficacy

The FRISK (Fracture Risk)-A New Tool to Indicate the Probability of Fractures.

Increasing patient inflow into the emergency department makes it necessary to optimize triage management. The scope of this work was to determine simple factors that could detect fractures in patients without the need for specialized personnel. Between 2014 and 2015, 798 patients were admitted to an orthopedic emergency department and prospectively included in the study. The patients received a questionnaire before contacting the doctor. Objective and subjective data were evaluated to determine fracture risk for the upper and lower extremities. The highest risk for fractures in one region was the hip (73.21%; n = 56), followed by the wrist (60.32%; n = 63) and the femoral shaft (4 of 7, 57.14%; n = 7). The regions with the lowest risk were the knee (8.41%; n = 107), the ankle (18.29%; n = 164), and the forearm shaft (30.00%; n = 10). Age was a predictor for fracture: patients older than 59 years had a risk greater than 59.26%, and patients older than 90 years had a risk greater than 83.33%. The functional questions could exclude fractures. Three factors seem to be able to predict fracture risk: the injured region, the patient's age, and a functional question. They can be used for a probatory heuristic that needs to be proven in a prospective way.

The Femoral Nerve Block Setting the Agenda for Nursing Care of Older Patients With hip Fractures-A Qualitative Study.

Hip fractures among older people are common worldwide, and it is often associated with preoperative pain. Due to increased comorbidity and high age, traditional pain relief can be a challenge. An alternative to traditional pain relief is a femoral nerve block, which is safe and suitable for anesthesia and analgesia for hip fractures among patients with or without dementia. It is essential to provide adequate pain management, and nurses report negative attitudes toward opioids and seem to prefer alternative pain management. To our knowledge, no study has focused on staff's experiences of nursing care for patients treated with femoral nerve block. To describe staff's experiences providing nursing care in preoperative pain and pain management to older patients with a hip fracture who received a femoral nerve block. A qualitative exploratory design. Semistructured interviews with 19 nurses or assistant nurses in an orthopedic ward or emergency department. They were experienced in caring for patients with hip fractures who received treatment with a femoral nerve block. The interviews were subjected to qualitative content analysis. Staff described the femoral nerve block as setting the agenda when caring for older patients with hip fractures in the preoperative phase. The outcome of the femoral nerve block affected nursing care, depending on if the femoral nerve block was successful or not. Nursing care requires timing, with a need for staff orienting to time and customizing their communication. Further, staff faced ethical challenges regarding doing good and not harm, relieving pain, and avoiding side effects. The femoral nerve block was an important issue for nursing staff in patients with hip fractures in the preoperative phase. Our results point toward the benefits of giving femoral nerve blocks as soon as possible to facilitate nursing care, however, this should be studied in future research.

How the COVID-19 Pandemic Affected Attendance at a Tertiary Orthopedic Center Emergency Department: A Comparison between the First and Second Waves.

Italy was the first European country to face the SARS-CoV-2 virus (COVID-19) pandemic in 2020. The country quickly implemented strategies to contain contagions and re-organize medical resources. We evaluated the COVID-19 effects on the activity of a tertiary-level orthopedic emergency department (ED) during the first and second pandemic waves. We retrospectively collected and compared clinical radiological data of ED admissions during four periods: period A, first pandemic wave; period B, second pandemic wave; period C, three months before the COVID-19 outbreak; period D, same timeframe of the first wave but in 2019. During period A, we found a reduction in ED admissions (-68.2% and -59.9% compared with periods D and C) and a decrease in white codes (non-urgent) (-7.5%) compared with pre-pandemic periods, with a slight increase for all other codes: +6.3% green (urgent, not critical), +0.8% yellow (moderately critical) and +0.3% red (highly urgent, risk of death). We observed an increased rate of fracture diagnosis in period A: +14.9% and +13.3% compared with periods D and C. Our study shows that the COVID-19 pandemic caused a drastic change in the ED patient flow and clinical radiological activity, with a marked reduction in admissions and an increased rate of more severe triage codes and diagnosed fractures.

Hair tourniquet syndrome: A retrospective study.

Hair thread tourniquet syndrome (HTS) is a pediatric condition in which human hair or synthetic fiber encircles and strangulates a body appendage causing tissue necrosis. Few epidemiologic studies have been done. Our objective was to better define the demographics, clinical features, and predisposing factors for this condition. Medical records of all infants up to 1 year old seen in the orthopedic emergency department of Galilee Medical Center were searched for the diagnosis of HTS or its ICD equivalent. Forty-one cases of hair tourniquet syndrome (HTS) were reviewed. Most cases (68%) occurred during the winter months (December to February). There were no reports between June to August (summer). The median age was 4months and the male-to-female ratio was approximately 2:5. Toes were significantly more involved than fingers (97.5%) and the 3rd toe was the most affected (58%). Nine patients (21.9%) had more than one toe affected and only one case reported finger involvement. HTS in our population is a phenomenon that seems to occur mostly in winter. Infants between 3 and 5months are at greater risk. Toes are more affected than fingers. The most involved toes are the 3rd and 4th.

PERCUTANEOUS CD FIXATION OF SPINE IN SPINAL FRACTURES/ INSTABILITY BY FREE HAND TECHNIQUE

Introduction: Lumbar spondylolisthesis is frequently found in adults as a result of spondylolysis or facet degeneration. The slipped segment produces abnormal positioning of the vertebrae in relation to each other along the spinal column and causes mechanical back pain and compression of neural structures. The initial treatment in most symptomatic patients with lumbar spondylolisthesis is nonoperative supportive care, which consists of a combination of pain medications, bracing, and physical therapy. Surgical intervention is indicated if the symptoms are disabling and they interfere with work despite supportive care, if there is progression of the slippage degree (SD) on serial radiologic examinations, or if there are overt neurological deficits 1,2. Pedicle screw placement is the most popular method in lumbar spinal instrumentation for achieving successful fusion. Recently, to reduce surgical damage to the normal muscular structures during pedicle screw placement, C-arm-guided percutaneous pedicle screw fixation (PPSF) was introduced, and it has become increasingly popular in spinal surgery. Percutaneous transpedicular fixation systems have become more widely used in recent years mainly for the treatment of dorsal, dorsolumbar, and lumbar instability. Aim &amp; Objectives: The present study is aimed at evaluating the functional outcome with percutaneous pedicle screw fixation for spinal fractures&amp; spinal instabilities by free hand technique in patients without neurological deficits. Materials &amp; Methods: The present dissertation is a study of 25 consecutive cases of spinal fractures and spondylolisthesis who attended the orthopaedic emergency or outpatient department of Andhra medical college, Visakhapatnam from 2017 to 2019. All the cases were examined clinically fallowed by radiographic confirmation. Results: In total 25 patients spinal fractures 16 and instability 9, whose mean preoperative ODI scores is 81.04% and the mean postoperative score is 22.6 %. The total postoperative moderate disability patients are15 and minimal disability patients are 10. “PERCUTANEOUS CD FIXATION OF SPINE IN SPINAL FRACTURES/INSTABILITY BY FREEConclusion: HAND TECHNIQUE” is one of the better methods and is suggested for grade 1 &amp; grade 2 spondylolisthesis and spinal fractures, also by which can reduce the morbidity and improve the function.

Detecting bone lesions in the emergency room with medical infrared thermography

IntroductionLow- to high-energy impact trauma may cause from small fissures up to extended bone losses, which can be classified as closed or opened injuries (when they are visible at a naked eye).ObjectiveThe aim of this study was to investigate the feasibility of clinical diagnosis of bone trauma through medical infrared thermography, in a hospital emergency room.MethodsForty-five patients with suspected diagnosis of bone fracture were evaluated by means of medical infrared images, and the data correlated with the gold standard radiographic images, in the anteroposterior, lateral, and oblique views, at the orthopedic emergency department. The control group consisted of thermal images of the contralateral reference limb of the volunteers themselves. Data were acquired with a medical grade infrared camera in the regions of interest (ROIs) of leg, hand, forearm, clavicle, foot, and ankle.ResultsIn all patients evaluated with a diagnosis of bone fracture, the mean temperature of the affected limb showed a positive difference greater than 0.9 °C (towards the contralateral), indicating the exact location of the bone trauma according, while the areas diagnosed with reduced blood supply, showed a mean temperature with a negative variation.ConclusionClinical evaluation using infrared imaging indicates a high applicability potential as a tool to support quick diagnosis of bone fractures in patients with acute orthopedic trauma in an emergency medical setting. The thermal results showed important physiological data related to vascularization of the bone fracture and areas adjacent to the trauma well correlated to radiographic examinations.

Lockdown imposition due to COVID-19 and its effect on orthopedic emergency department in level 1 trauma center in South Asia

BackgroundThe coronavirus pandemic brought the entire world to a standstill. One of the most stringent lockdowns in the world was implemented in India. With the entire healthcare system being stretched, emergency orthopaedic services also take a hit. We studied the trends in patient presentation, testing, management, and restructuring of doctors at a tertiary care orthopaedic centre and compared them with the data from the same time period the previous year (2019). MethodData was collected separately for all the 5 different phases of lockdown and unlock, as well as for the same duration of months in 2019, and was analysed for epidemiological trends. ResultsA rapid fall in the total number of cases was seen during the lockdown, followed by a skewed rise during the unlock. Forearm, wrist, and hip fractures were the most common fractures. Once nucleic acid testing of all patients intended to be admitted was started, a steep rise in coronavirus positivity was seen. There was a reduction in the total number of cases compared to 2019, but it was not as significant as would have been expected due to the complete standstill of activity during the lockdown. ConclusionDuring a pandemic, with the healthcare system under a crisis of workforce and infrastructure, there needs to be a separate task force for catering to orthopaedic emergencies since all fractures cannot be managed conservatively and the numbers of trauma-related patients did not show a stark fall as compared to normal months of last year. Level of evidenceLevel 3 Retrospective Case Series

124 Administration of Fascia Iliaca Block to Patients Who Have Suffered a Neck of Femur Fracture

Abstract Aim Hip fractures are the most common serious injury affecting elderly people and are associated with a total cost to the health and social services over £1 billion per year. This injury takes approximately 1% of the NHS budget. Furthermore current 30-day mortality rate is 6.5% so has serious implications for patients. NICE recommend that nerve blocks should be used to help perioperative pain and limit the use of opioids. We audited our use of analgesia, especially fascia iliaca blocks (FIB), to see whether training could improve the management of these patients. Method We conducted a retrospective cohort study in which a total of 188 patients, who had sustained a hip fracture, were audited during 4 discrete periods between March 2021-July 2021. The primary outcome assessed was whether they had received a FIB preoperatively. Improvements were implemented between audit cycles to see if they achieved desired outcomes. Results Implementation of good quality teaching to orthopaedic juniors and emergency department registrars and juniors successfully improved rate of FIB from 2.5% to 47%. The rate of FIB was not sustained over time and declined to 22%. Factors thought to influence this decline included regular rotation of junior doctors and increasing time pressures in the emergency department. Conclusions Our data suggested that low rates of FIB resulted in high opioid use in the emergency department. Allocated teaching sessions on administration of FIB were a successful way to improve use of blocks and reduce opioid use.

Interrater reliability of physical examination tests in the acute phase of shoulder injuries

BackgroundThe physical examination is one of the cornerstones of the diagnostic process in patients with acute shoulder injuries. The discriminative properties of a given examination test depend both on its validity and reliability. The aim of the present study was to assess the interrater reliability of 13 physical examination manoeuvres for acute rotator cuff tears in patients with acute soft tissue shoulder injuries.MethodsIn a large walk-in orthopaedic emergency department, 120 consecutive patients ≥40 years of age were included in a diagnostic study. Patients who had follow-up within three weeks of an acute shoulder injury without fracture on radiographs were eligible. Four emergency department physicians participated as examiners. In a subset of 48 patients, the physical examination tests were performed by two physicians, randomly chosen by their work rotation. The physicians were blinded to the findings of each other and the results of the ultrasound screening. The interrater reliability was assessed by Cohen’s kappa, intraclass correlation coefficient (ICC), standard error of measurement (SEM) and Bland-Altman plots depending on whether the examination test result was registered as a binary, ordered categorical or continuous numerical variable.ResultsThe median age was 55.5 years, 46% were female. Twenty-seven percent had a rotator cuff full-thickness tear on ultrasound screening; all but one involved the supraspinatus tendon. Cohen’s kappa for binary tests ranged from excellent to fair. Excellent agreement (kappa > 0.8) was found for the inability to abduct above 90° and abduction strength. External rotation strength expressed substantial agreement (kappa 0.7). The lowest scores were registered for Hawkins` test and the external rotation lag sign (kappa 0.25 and 0.40, respectively). The ICCs for active range of abduction and external rotation were 0.93 (0.88–0.96) and 0.84 (0.72–0.91), whereas the SEM was 15 and 9, respectively.ConclusionsThe results indicate that examination manoeuvres assessing abduction and external rotation range of motion and strength are more reliable than manoeuvres assessing pain in patients in the acute phase of traumatic shoulder injury. The poor agreement observed is likely to limit the validity in the present setting of two commonly used tests.Trial registrationThe Norwegian Regional Ethics Committee South East (2015/195).

A cross-sectional study on the impact of the prevention and control response of the COVID-19 pandemic on minor\u2019s orthopedic trauma in Shanghai

BackgroundThe Chinese government has taken strong prevention and control measures against the COVID-19 pandemic. Although the pandemic is far from over, it has been effectively controlled in China. The outbreak of COVID-19 pandemic provides an opportunity to study the influence of governmental prevention and control response on orthopedic trauma in minors.MethodsWe collected and reviewed data and information on minor’s orthopedic trauma from 1 January to 30 June of the past three year (2018, 2019 and 2020). The data were divided according to the time of prevention and control response level in 2020 (the first level response is from January 24 to March 22, the second level response is from March 23 to May 7, and the third level response is May 8 to now). By comparing the relevant data from orthopedic emergency and operating rooms from the past three years, the influence of governmental pandemic prevention measures on orthopedic trauma in minors was analyzed.ResultsA total of 36,301 minors were included in the study cohort. Before the prevention and control response, the data of the orthopedic emergency department of National Children Medical Center (Shanghai) in 2020 was the same as the previous two years. The condition of children undergoing surgery at the time of injury is significantly different under different levels of prevention and control response. Under the first-level response, the number of fractures, open injuries, radial head subluxation, and surgery were significantly reduced, and the severity of patients with surgery was also significantly reduced. Under the second-level response, the number of operations began to increase, and the severity of the disease also began to rise. Under the third-level response control, the number of fractures, open injuries, and operations have returned to the levels of the previous two years. The severity of the operation has also returned to its previous level. The number of subluxations of the radial head is still different from before.ConclusionThe prevention and control response for the pandemic of COVID-19 can reduce the incidence of orthopedic trauma in minors by strengthening the guardian’s care and restricting children’s outdoor activities. With the control of the pandemic, the amount of orthopedic trauma in minors will not be affected by low-level prevention and control.

Impact of COVID-19 Pandemic on Orthopedics and Traumatology Service

Objectives: Each country has followed different paths in the fight against the COVID 19 pandemic that started in 2019. The pandemic and the measures taken have affected the whole country. The aim of this study was to investigate how the pandemic affected the practice in the orthopedic clinic.&#x0D; Methods: Patients who presented at the Orthopedic Outpatients Clinic and Emergency Department with orthopedic complaints between March 15, 2020 and April 15, 2020, were screened. The diagnoses and treatments applied to these patients were recorded. These data were compared with equivalent periods in 2019 and 2018.&#x0D; Result: There was a significant increase in home accidents, sharp object injuries and diabetic foot wounds compared to the last two years, and a decrease in workplace accidents, traffic accidents and sports injuries (p= 0.040, p=0.000, p=0.037, respectively). The frequency of hip and wrist fractures increased, and the frequency of ankle fractures decreased (p=0.044, p=0.002, p=0.001, respectively).&#x0D; Conclusion: It was seen that dealing with the pandemic should not only include interventions against the causative agent. Psychological support for individuals, attention focussed on home accidents, and the provision of home exercises, especially for senior citizens, should be recommended.

Predictive Value of Serum Vitamin D3 Level for Forearm Fractures among Children in a Tropical Country: A Case Control Study

Introduction: Orthopaedic emergency department commonly receives paediatric fractures, of which forearm fractures constitute a larger proportion with the burden greatest in low-middle income countries. Studies done in the temperate region found an association between forearm fractures in children and low serum vitamin D3. Some studies in our environment have shown low levels of 25-hydroxy vitamin D3 {25(OH)D} in normal Nigerian children, but the association with forearm fractures has not been studied. Aim: To determine if serum vitamin D3 level can predict the occurrence of forearm fractures in children. Materials and Methods: This was a case control study conducted over a year from January 2018 to December 2018 at a tertiary health facility in South-West Nigeria among paediatric patients. Thirty children with forearm fractures and thirty children with no forearm fractures were recruited for the study. Socio-demographic data, mechanisms of fracture, anthropometric measurements and serum 25(OH)D levels were determined. Univariate and multivariate analyses were done for the variables concerning the presence or absence of forearm fractures (dependent variable is the presence or absence of forearm fractures; independent variables include the age, sex, mechanism of injury, outdoor playing time, serum vitamin D3 level). Results: The mean serum 25(OH)D levels in the study group were significantly lower than the controls; (60.751±15.041 ng/mL and 95.506±19.489 ng/mL, respectively). There was a statistically significant relationship between the serum level of 25(OH)D and the presence of forearm fracture in children (p=0.002 and OR of 0.838). Conclusion: Children with forearm fracture have relatively lower serum vitamin D3 compared with age matched ones without fracture and they have correspondingly increased odd risks of sustaining forearm fracture.